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Title VI Discrimination Complaint (Federally Funded Programs)
Complaint alleging discrimination based on race, color, or national origin in a program or activity receiving federal financial assistance, in violation of Title VI of the Civil Rights Act.
PDF TemplateUse the instructions below to complete this form
Instructions
File with the federal agency that provides funding to the program (e.g., DOJ, HHS, DOE, DOT). Include the name and address of the federally funded entity, a description of the discriminatory act, the basis of discrimination, and dates. File within 180 days of the last discriminatory act. The agency will investigate and may withhold federal funding from violators. Title VI also covers disparate impact discrimination, not just intentional discrimination.